Training Residents in Genomics (TRIG)

A series of online modules have been created to simulate the team-based learning (TBL) experience offered at the over 20 genomic pathology in-person workshops conducted by the Training Residents in Genomics Working Group (TRIG). Released in 2016, the four core areas of the TRIG curriculum are covered: single gene testing; prognostic gene panel testing; design of a multigene assay and whole exome sequencing. Following introductory information providing the curricular framework, each of the four core modules consist of the following components 1) An instructor-delivered 15-30 minute interactive PowerPoint lecture that allows the participant to answer preparation questions and review content needed to undertake the TBL activity. 2) A 30-45 minute activity simulating the TBL environment. The participant answers questions with their “team” and learns, through guided simulation, the use of online genomics tools. 3) An instructor-delivered 15-30 minute PowerPoint lecture presenting answers to the activity questions. At the end of the final module there is also a summary of the key concepts and a short review of non-oncology genomic testing. About TRIG: The TRIG Working Group was formed through the Pathology Residency Directors Section (PRODS) of the Association of Pathology Chairs (APC). The goals of this group, made up of experts in medical education, molecular pathology, and clinical genetics, are to develop teaching tools and promote genomic pathology education. The TRIG Working Group represents a unique collaborative effort in pathology education with members from many major pathology organizations and representatives from the National Society of Genetic Counselors and American College of Medical Genetics and Genomics. The development of TRIG Working Group resources is supported by an R25 grant from the National Cancer Institute with administrative and educational design support provided by the American Society for Clinical Pathology.


Note to Physician Assistants: The primary focus of this resource is to provide tools to teach genomic testing to pathology residents. An introduction and four online genomic pathology modules are provided: single gene testing, prognostic gene panel testing, design of a multigene assay, and whole exome sequencing. These modules will provide the physician assistant with knowledge of genomic tests used by pathologists, in collaboration with genetic counselors and medical geneticists, to provide patients with personalized risk prediction, medication dosing, diagnosis, and prognosis.


Type Course
CME Available No
Topic
Cost Free
Note



Genomic Competencies

Experts from the disciplines listed below have tagged this resource as fulfulling genomic competencies.

Physician Assistant

  • Patient Care
    • 4:   Incorporate genetic tests into patient management
    • 5:   Discuss the range of genetic and genomic-based approaches to the treatment of disease.
  • Practiced-based Learning and Improvement
    • 1:   Use information technology to obtain current and credible information about genetics for self, patients, and colleagues

Nurse

  • Identification
    • ID-2:   Identify credible, accurate, appropriate, and current genetic and genomic information
      • ID2-K1:   Resources for health care professionals and lay public
        • ID2-1:   Evaluate strengths, limitations, and best use of genetic and/or genomic resource for a client or group of clients.
        • ID2-2:   Discuss the ways in which nurses can meet the educational, psychosocial and resource needs of clients and families affected by a genetic or genomic condition.
        • ID2-3:   Discuss the ways in which nurses can meet the knowledge, psychosocial and resource needs of clients and families affected by genetic/genomic technology.
        • ID2-4:   Identify resources available to assist clients seeking genetic and genomic information or services including the types of services available.
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
        • ID2-6:   Evaluate sources of evidence and clinical practice guidelines for a client whose care involves genetic and/or genomic health care. Use continuous quality improvement initiatives to update practice guidelines as necessary.
      • ID2-K2:   Resources for referral within one's community
        • ID2-1:   Evaluate strengths, limitations, and best use of genetic and/or genomic resource for a client or group of clients.
        • ID2-2:   Discuss the ways in which nurses can meet the educational, psychosocial and resource needs of clients and families affected by a genetic or genomic condition.
        • ID2-3:   Discuss the ways in which nurses can meet the knowledge, psychosocial and resource needs of clients and families affected by genetic/genomic technology.
        • ID2-4:   Identify resources available to assist clients seeking genetic and genomic information or services including the types of services available.
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
        • ID2-6:   Evaluate sources of evidence and clinical practice guidelines for a client whose care involves genetic and/or genomic health care. Use continuous quality improvement initiatives to update practice guidelines as necessary.
      • ID2-K3:   Roles of genetic/genomic health care professionals
        • ID2-1:   Evaluate strengths, limitations, and best use of genetic and/or genomic resource for a client or group of clients.
        • ID2-2:   Discuss the ways in which nurses can meet the educational, psychosocial and resource needs of clients and families affected by a genetic or genomic condition.
        • ID2-3:   Discuss the ways in which nurses can meet the knowledge, psychosocial and resource needs of clients and families affected by genetic/genomic technology.
        • ID2-4:   Identify resources available to assist clients seeking genetic and genomic information or services including the types of services available.
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
        • ID2-6:   Evaluate sources of evidence and clinical practice guidelines for a client whose care involves genetic and/or genomic health care. Use continuous quality improvement initiatives to update practice guidelines as necessary.
      • ID2-K4:   Interprofessional resources
        • ID2-1:   Evaluate strengths, limitations, and best use of genetic and/or genomic resource for a client or group of clients.
        • ID2-2:   Discuss the ways in which nurses can meet the educational, psychosocial and resource needs of clients and families affected by a genetic or genomic condition.
        • ID2-3:   Discuss the ways in which nurses can meet the knowledge, psychosocial and resource needs of clients and families affected by genetic/genomic technology.
        • ID2-4:   Identify resources available to assist clients seeking genetic and genomic information or services including the types of services available.
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
        • ID2-6:   Evaluate sources of evidence and clinical practice guidelines for a client whose care involves genetic and/or genomic health care. Use continuous quality improvement initiatives to update practice guidelines as necessary.
  • Referral activities
    • RA-1:   Facilitate referrals for specialized genetic and genomic services
      • RA1-K1:   Professional roles of providers delivering genetic and genomic services
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
      • RA1-K2:   Resources for health care professionals and lay public
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
      • RA1-K3:   Resources for genetic and genomic referrals within the community
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
  • Provision of education, care and support
    • PECS-1:   Provide clients with interpretation of genetic and genomic information
      • PECS1-K1:   Components of family history
        • PECS1-1:   Discuss factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or a genetic/genomic condition.
        • PECS1-2:   Use family history information to inform health education.
        • PECS1-3:   Discuss the role of genetic, genomic, environmental and psychosocial factors in the manifestation of disease.
        • PECS1-5:   Reinforce/clarify information provided by genetic professional to client (i.e., genetic test interpretation; informed consent).
      • PECS1-K2:   Inheritance Patterns
        • PECS1-1:   Discuss factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or a genetic/genomic condition.
        • PECS1-2:   Use family history information to inform health education.
        • PECS1-3:   Discuss the role of genetic, genomic, environmental and psychosocial factors in the manifestation of disease.
        • PECS1-5:   Reinforce/clarify information provided by genetic professional to client (i.e., genetic test interpretation; informed consent).
      • PECS1-K3:   Role of environmental and psychosocial factors
        • PECS1-1:   Discuss factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or a genetic/genomic condition.
        • PECS1-2:   Use family history information to inform health education.
        • PECS1-3:   Discuss the role of genetic, genomic, environmental and psychosocial factors in the manifestation of disease.
        • PECS1-5:   Reinforce/clarify information provided by genetic professional to client (i.e., genetic test interpretation; informed consent).
      • PECS1-K4:   Informed consent procedures and essential elements
        • PECS1-1:   Discuss factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or a genetic/genomic condition.
        • PECS1-2:   Use family history information to inform health education.
        • PECS1-3:   Discuss the role of genetic, genomic, environmental and psychosocial factors in the manifestation of disease.
        • PECS1-5:   Reinforce/clarify information provided by genetic professional to client (i.e., genetic test interpretation; informed consent).
    • PECS-2:   Provide clients with genetic and genomic information and resources for informed decision making
      • PECS2-K1:   Resources for healthcare professionals and lay public
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
      • PECS2-K2:   Referral resources for genetic and genomic services within one's community
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
      • PECS2-K3:   Roles of genetic/genomic health care professionals
        • ID2-5:   Develop a list of contacts and resources for genetic/genomic referrals.
    • PECS-8:   Evaluate impact and effectiveness of technology, information, interventions, and treatments
      • PECS8-K1:   Range of psychosocial responses
        • PECS8-1:   Assess client response to genetic/genomic information.
        • PECS8-2:   Assess client response to genetic/genomic based interventions.
        • PECS8-3:   Assess client response to genetic/genomic services.
        • PECS8-4:   Use evaluation of genetic/genomic technology, information and interventions to modify client's plan of care.
      • PECS8-K2:   Expected outcomes of various genetic/genomic based interventions
        • PECS8-1:   Assess client response to genetic/genomic information.
        • PECS8-2:   Assess client response to genetic/genomic based interventions.
        • PECS8-3:   Assess client response to genetic/genomic services.
        • PECS8-4:   Use evaluation of genetic/genomic technology, information and interventions to modify client's plan of care.

Physician

  • Genomic Testing
    • P-GT2A:   Patient Care
      • 2A1:   Discuss the indications for genomic testing - specifically the benefits, risks, and alternatives
      • 2A2:   Explain the implications of placing genomic test results in the patient’s medical record
      • 2A3:   Discuss the possibility of incidental findings and how they will be handled
      • 2A4:   Discuss risks of having genomic testing done: e.g., psychological implications for the individual as well as the family; the potential for discrimination; and the potential effect on insurance coverage.
      • 2A5:   Explain to the patient issues of costs and financial coverage of genomic testing
      • 2A6:   Order, interpret, and communicate the results of appropriate genomic tests, within the physician’s scope of practice
      • 2A7:   Provide referral to an appropriate specialist for genomic testing of a condition outside the physician’s scope of practice
      • 2A8:   Respond to the results of an abnormal genetic screening test, such as newborn screening, including immediate management and appropriate referral
    • P-GT2B:   Knowledge for Practice
      • 2B1:   Describe the major forms of genomic variability
      • 2B2:   Explain how different genomic changes may result in different phenotypes
      • 2B3:   Recognize that genomic tests require interpretation with respect to the patient’s clinical status (e.g., pathogenic, likely pathogenic, benign)
      • 2B4:   Explain the concepts of analytic validity, clinical validity, clinical utility as they relate to genomic testing
      • 2B5:   Recognize that medically ’non-actionable’ genomic results can be useful to the patient and family (i.e., personal utility)
  • Patient Treatment Based on Genomic Results
    • P-PM3A:   Patient Care
      • 3A1:   Identify medical conditions and drug responses that have a strong genetic component
      • 3A2:   Recognize that variants affecting drug responses found in a patient may also have implications for other family members
      • 3A3:   Discern the potential clinical impact of genetic variation on risk stratification and individualized treatment
    • P-PM3B:   Knowledge for Practice
      • 3B1:   Appreciate the importance of genetic diversity of humans and the abundance of genetic variants in each individual genome
      • 3B2:   Identify single-gene disorders that may be amenable to targeted pharmacological therapy
      • 3B3:   Recognize that genomic test results may guide choice of therapy for multifactorial disorders
      • 3B4:   Recognize that there is variability in the phenotypic expression of genetic variants and in response to therapy
      • 3B5:   Recognize that the effects of some medications are strongly influenced by inherited or somatically acquired genetic variation

Genetic Counselor

  • Genetics Expertise and Analysis
    • 1:   Demonstrate and utilize a depth and breadth of understanding and knowledge of genetics and genomics core concepts and principles.
      • 1a:   Demonstrate knowledge of principles of human, medical, and public health genetics and genomics and their related sciences.
      • 1b:   Apply knowledge of genetic principles and understand how they contribute to etiology, clinical features and disease expression, natural history, differential diagnoses, genetic testing and test report interpretation, pathophysiology, recurrence risk, management and prevention, and population screening.
    • 2:   Integrate knowledge of psychosocial aspects of conditions with a genetic component to promote client well-being.
      • 2a:   Demonstrate an understanding of psychosocial, ethical, and legal issues related to genetic counseling encounters.
      • 2b:   Describe common emotional and/or behavioral responses that may commonly occur in the genetic counseling context.
    • 3:   Construct relevant, targeted and comprehensive personal and family histories and pedigrees.
      • 3a:   Demonstrate proficiency in the use of pedigree symbols, standard notation, and nomenclature.
      • 3b:   Utilize interviewing skills to elicit a family history and pursue a relevant path of inquiry.
    • 4:   Identify, assess, facilitate, and integrate genetic testing options in genetic counseling practice.
      • 4a:   Investigate the availability, analytic validity, clinical validity, and clinical utility of screening, diagnostic and predictive genetic/genomic tests.
      • 4b:   Evaluate and assess laboratories and select the most appropriate laboratory and test based on the clinical situation.
      • 4c:   Identify and discuss the potential benefits, risks, limitations and costs of genetic testing.
      • 4d:   Coordinate and facilitate the ordering of appropriate genetic testing for the client.
      • 4e:   Interpret the clinical implications of genetic test reports.
      • 4f:   Recognize and differentiate specific considerations relevant to genetic versus genomic and clinical versus research testing in terms of the informed consent process, results disclosure, institutional review board (IRB) guidelines, and clinical decision-making.
    • 6:   Demonstrate the skills necessary to successfully manage a genetic counseling case.
      • 6a:   Develop and execute a case management plan that includes case preparation and follow-up.
      • 6b:   Assess and modify the case management plan as needed to incorporate changes in management and surveillance recommendations.
      • 6c:   Document and present the genetic counseling encounter information clearly and concisely, orally and in writing, in a manner that is understandable to the audience and in accordance with professional and institutional guidelines and standards.
      • 6d:   Identify and introduce research options when indicated and requested in compliance with applicable privacy, human subjects, regional and institutional standards.
      • 6e:   Identify, access and present information to clients on local, regional, national and international resources, services and support.